119th Annual Convention
Washington D.C., August 4-7 2011

The symposium chair, Elizabeth K. Carll,Ph.D. introduced today's topic with an overview of technological applications and their impact on psychologists' activities in particular, ranging from training to consultative roles to applied clinical practice. She noted the increasing use of powerful tools which utilize "augmented reality", and "virtual reality" applications in particular. Across a broad range of clinical activity, new tools are available, and are clearly impacting the way in which psychologists approach treatment.

The first to present was "Skip " Rizzo, Ph.D., of USC and the Institute for Creative Technologies - Clinical Virtual Reality Research Group, addressing today (among other things) "The Birth of Intelligent Virtual Humans in Clinical Virtual Reality." The Clinical VR Research Group today has 4 affiliated labs, each with a particular focus: The VRPsych Lab, whose logo pictures Freud wearing immersive VR goggles; the NeuroSim Lab; Motor Rehab Lab, and Virtual Patient Lab.

Dr. Rizzo had just given a presentation the day before - with a different panel, with a particular focus on avatars and virtual environments. Those following this topic may want to take in (virtually) that presentation as well. One thing he presented on both occasions is important contextually, and bears repeating: his definition of "Virtual Reality".

Within such controllable, dynamic and interactive 3D stimulus environments, behavioral action can be motivated, recorded and measured."

HumanCentric Definition:

"...a way for humans to interact with computers and extremely complex data in a more naturalistic fashion."

Virtual Reality as a Simulation Technology

Dr. Rizzo presented a series of photographs and futuristic images of VR apparatus, across time, beginning with the 1st Link- Aviation Simulator (appearing much like an arcade-sized airplane with a built-in simulator screen) , from 1929. That was a grandaddy of today's Virtual Reality. Tracing the history from then until now, we are soon in the early 1990's, with huge displays, children embracing computers and keyboards and games, all sorts of headgear for virtual reality, and an explosion of technological advances in general. A slide depicts images and a quote from that time period: "Virtual Reality arrives at a moment when computer technology in general is moving from automating the paradigms of the past to creating new ones for the future." (Myron Krueger, 1993). This, Rizzo shared, " influenced me".

In 1994, VR really got its start in a major way with the introduction of its use in "exposure therapy" treatments. And it has been developing, gaining in use and applications, and consistently found (in both research and clinical practice) to offer powerful and effective treatment tools.

Several of Virtual Reality's Assets were listed and described:

Ecological validity

Stimulus control and consistency ["the ultimate Skinner box"]

Repetitive and hierarchical stimulus delivery possible

Cueing stimuli for "errorless learning"

Real time performance feedback

Self-guided exploration and independent practice

Stimulus and response modification contingent on user's impairments

Complete naturalistic performance record

Safe testing and training environment which minimizes risks due to errors

Graduated, systematic exposure

Distraction

Gaming factors to enhance motivation

Low cost functional environments that can be duplicated and distributed

From the early days, like 1994 - when the focus was on simple phobias - to 2011, where applications address many areas, including addiction, ADHD, Alzheimers, Anxiety disorders, Autism (e.g., social skills training; Cobb et al, 2002), Balance Disorders, Cerebral Palsy, Neglect, Pain Distraction, Phantom Limb, PTSD, Stroke, TBI, Parkinsons, Spinal Cord injury, and more... Clearly there is great power and more potential still, with constant innovation and applied research. Far more realistic and customizable than the early treatments for simple phobias, recent VR applications feature such "cue exposure treatment" tools as simulated airline terminals (for fear of flying) and contextual environments which relate to social phobias, PTSD, and substance abuse. A treatment module deployed in Spain was also presented, where patients with claustrophobia were presented with a computer-generated image of a room becoming smaller and smaller.

Now, an intriguing on-screen image asks: What about Virtual Humans?

In terms of realism, there is variability across the programs, and many times humans still appear as static characters who 'pop in' - for example as 'distracters' in the simulated classroom environment where children learn to better master their focusing skills. Still, both background and participant representations have gotten extremely realistic in a variety of applications, and as was pointed out by Richard Wexler in an earlier presentation on avatars and VR/VE, the brain can readily accept these presentations as real, or at least real enough.

We can see several examples of virtual environments in numerous contexts, including the workplace, public speaking venues (e.g, Grillon, Riquier, Herbelin & Thalmann, 2009), airports, combat situations, medical settings and more.

-- a vehicle to promote Avatar Interaction with other real people (i.e. 2nd Life)

Recognition of the value and utility of VR/VE applications is clearly on the rise, as demonstrated by a bar graph showing the yearly number of publications on 'avatar/autonomous agents' and 'VR/VE', according to the COPUS (2009) database.

Positive outcomes of clinical applications have also been on the rise. Botella et al (2007) for example, followed 36 patients being treated for Panic Disorder and Agoraphobia using a VR/VE treatment protocol. The results were not only significant, but for some perhaps an 'eye-opener': "Virtual Human Exposure as good as the real thing!" A preliminary study by Klinger, Bouchard, et al (2005)had found similar comparability in using CBT vs. VR treatment for Social Phobia. Rothbaum et al (2008) reported significant results in a study of virtual environments used to address fear of public speaking . A screenshot was shown of Virtually Better, a pioneer in VE/VR development, and the acclaimed Virtual Iraq. Finally Rizzo shared a collage of images from ICT's 'Virtual Humans Portfolio' which ranged from various military personnas, to a museum guide, a gunslinger, and a large assortment of virtual patients.

Virtual Patients

Another new and valuable implementation of VR technology is seen among programs which, unlike immersion of patients into controlled and self-contained environments, are designed to enable physicians, medical students, psychologists and other health professionals to gain practice and hone skills through interaction with virtual patients. One can interact with a life-size virtual patient (VP) locally, interview a VP via the web, or visit a VP in Second Life. Lok et al (2008-2011) have been doing research in this particular area, and the results are promising. In addition to things like general diagnostic interviews and developing 'bedside manners', there area specialized models to hone in on different types of typical patient presentations: An image is onscreen of a virtual teen saying "I don't want to be here!" Another virtual patient suffers from PTSD. A third VP is the victim of sexual assault.

Dr. Rizzo noted that our brains seem to readily act with VR, and in turn the applications are becoming ever more adept at seamlessly responding to us, for example through voice recognition, and reading of gestures. His own research (Rizzo, Parsons & Kenny, 2010) has led to his finding that "clinicians buy in" as well, and ask the same questions that they might ask of a real human before them.

And this led to the final piece of Rizzo's presentation, a look at some of the work being done at ICT, including one project in particular he feels 'is where it's at': Sim Coach. [The slide shows some virtual soldiers, and states the goal: "Breaking Down Barriers to Care in Military Personnel and Their Families".] We are shown a demonstration, and we join a virtual veteran, siting on his porch with a cup of coffee, talking to us in a calm voice with a soothing Southern US accent: "I'm still just a piece of software but I'm getting better all the time.". He looks and sounds realistic, and engenders trust. A screenshot of the entry page: The dialogue screen to the right of our page host asks for some basic information "to get to know you better.... I think I can help you better if I know where you're coming from."

A report of the military's Mental Health Advisory Team (2009) was referenced, with the data reflecting widespread concern among soldiers serving in Afghanistan, that their careers might be hurt if they sought behavioral healthcare, they would be treated differently, blamed for their problem, seen as weak, etc. The numbers were so striking - up to 50% of respondents indicating those beliefs, that military leadership mobilized to find some method of providing acceptable treatment. General George W. Casey Jr. wrote (American Psychologist, 2011): "Facing statistics like these, we must ensure that our efforts to become psychologically stronger are not thwarted by a culture adverse to even the word psychological." [Casey also was highly receptive to the ideas of Seligman, who speaks of 'positive health' training for the military - this is described in detail elsewhere on this site, in a separate report.]

One solution: SimCoach. The summary of benefits onscreen now describes "an intelligent, interactive Virtual Human Agent program...Designed to attract and engage Service Members and their significant others who might not otherwise seek help (stigma, lack of awareness or a general reluctance to seek help).". A goal is to "create an experience that will motivate users to take the first step to empower themselves with regard to their healthcare (e.g., psychological health and traumatic brain injury), general personal welfare.. [and encouragement to take] the next step towards seeking more formal resources that are available with a live provider. " (For example, the program might refer to a health professional or to AA). A goal is to "support users' efforts to understand their situation better, explore available options and initiate the treatment process when needed.... [Notice is given that] SimCoach will not provide diagnostic or therapy services."

More information from the military's perspective is available via this link [.pdf]. More online information and materials pertaining to SimCoach, is also available from the ICT project page.

Back to the demo. Similar to Beating the Blues and some of the other programs demonstrated earlier by Kate Cavanagh (who presented on computerized CBT programsusing virtual environments) one has the ability with SimCoach to choose from some icons or 'buttons' depicting a virtual person, and select a character you're most comfortable with. Onscreen now: the army avatar is talking softly and calmly as he offers "3 things which can help... here's some links to help you....If you want you can register and save this conversation."

Sample virtual person #2: "Are you concerned about your drinking?" Links to contact the local AA are offered, and also "I could refer you to some people..." And as the presentation wound down, a few last screen shots showed some of the range of hardware being used, as well as a shot of "The Digital Homestead... the future of home-based care... advanced displays... low-cost interaction... 3D... "

Time was up, and this was quite an immersive experience in its own rite! A final comment was certainly well-received, by this audience comprising a wide swath of psychologists, young and older, clinicians, researchers and 'old fashioned therapists' of every stripe. Dr. Rizzo ended, after all this vision of a new and dazzling world of opportunity with the simple statement that "nobody's saying this replaces good clinical practice. Technology is a tool." Amen to that.

The final slide thanked Dr. Carll for organizing this event, and on that note she returned to the podium, thanking him in turn. Dr. Carll asked the audience, "How many people have used VR?" Many hands went up. Carll commented that in 2003 no hands went up in response to that question. [FWIW - I like to recall that in 1999 when I presented on Cyberpsychology, the questions I heard were 'What's a browser?' and 'How do you get a home page?' And for context, in 2003 there was still no such thing as... Facebook! Yes, the times they are a'changin! ]

And with that Dr. Carll introduced the next speaker, a pioneer in the area of VR-based pain-distraction (U. of Washington, HIP Lab).

Hunter Hoffman, Ph.D.Virtual Reality Applications for Pain Management

Dr. Hoffman spoke today about one aspect of VR application which had not been focused upon elsewhere today, relating specifically to an important healthcare area: pain management. He presented a look at one application in particular which has proven very promising in use with burn victims: Snow World.

He began with a video clip showing children who had been badly burned, like the one pictured above, engaged in 'pain distraction' activity during the extremely painful time when their wound dressing is changed. With extensive burns, we are told, one must constantly remove burnt tissue or it will become infected. In fact, burn wound care can be so painful that morphine is inadequate for pain control. Even the thought of wound maintenance is so painful that often one sees strong negative reactions in just being told it's time to change a wound dressing. Not only is the procedure intensely painful physically, but "it is the only time patients see the wound...it rivets their attention and makes it worse. So the VR blocks the patients view of the real world [and] the instruments of pain."

The SnowWorld program takes the patient away from what is happening in the room to an immersive environment with snow drifts, snowmen, penguins, and all sorts of cool, frosty images. "Their attention is focused on the virtual world". There are specialized, customized immersion goggles, and even applications from within a water-treatment chamber.

Onscreen: a boy is en route to wound care, and rather than panicking over the impending pain announces with some bravado, "Watch out, you Snowmen!"

And it's not only applicable to children. A video clip shows a soldier who has been burnt all over, in serious pain, but in the clip is immersed in a world of penguins and snow, with a Paul Simon music soundtrack accompanying the visual experience.

Not only is it the case that "patients report less pain in SnowWorld" but MRI's confirm a physiological impact along with the subjective reports: there are fewer 'pain signals' observed in the brain compared with the same procedures happening without the VR intervention.

Several efficacy studies were shared, and the results were quite impressive, such as a 40-50% reduction in reported pain. (e.g., Hoffman and Patterson, 2005)

Several other studies were cited, including one on VR vs. Nintendo as a distractor (VR 'won') and other studies which added a 'cognitive measure' beyond reports of pain and physiological evidence such as fMRIs. (e.g., "How much time do you spend thinking about pain?")

A few final points which come out of the extensive and growing research base:

1. "VR works best with the patients who need it most."
2. VR is not only effective, as had been predicted, with mild levels of pain, but can be dramatic in the treatment of high levels of pain as well."

--

Dr. Carll thanked Dr. Hoffman for a fascinating look at "the future of pain management" and the notion that perhaps much of this future might be non-pharmaceutical.

The next speaker is someone who can speak authoritatively to issues of both health and military applications. A psychiatrist and former officer with the US Air Force Medical Support Agency - and long-time advocate of VR treatments - he retired from the military in 2010 and is now medical director of Behavior Imaging Solutions.
[You can see his 2009 APA presentation while still serving in that capacity here, where he was part of a panel along with Richard Wexler, Les Paschall, and Stephane Bouchard, who was unfortunately not able to attend today's presentation as planned.]

Dr. Lacy began with the proposition that "all of us rely on assessments of brain function. We don't always observe it directly. What we see does not always reflect reality."

The Problem:

- Mental Health Providers Rely on Behavioral Observation
- Behavior seen in the Clinic does not equal 'Real Behavior'

We are relying on memory ... or family members reporting without personal bias." [e.g., in the case of someone in shock or otherwise unable to respond verbally.] We as clinicians and behavioral scientists rely heavily on visual observation in clinical assessment and treatment. At the same time, "the behavior observed in the clinic may not reflect the behavior that occurs in one's natural environment.

Dr. Lacy shared that his efforts stem in part from personal experience, as his son has a serious disability (autism) which involves behavioral components which in the past had been managed primarily with a stew of medications. But that masked behavior rather than allowing it to be observed and more appropriately addressed. A doc was called in to work with non-verbal treatment approaches, and it looked like a 'successful' session after 4 hours of observation and some on positive interaction. But 'it wasn't real', as the young man was heavily drugged during the 'evaluation'. This was a false snapshot ('behavioral image') of true daily-life functioning. It is this context which adds fuel to his passion for seeking realism, data, and validity in assessment and treatment/supervision - as well as for utilizing effective tools to document and address behavioral health / mental health needs.

Today Dr. Lacy will focus on "2 areas still posing problems for clinical practice and supervision" - areas which also require a "leap of faith" that what is being assessed is 'real.

It is his goal to develop 'a possible technological solution' for the purpose of

1) enhancing clinical care and supervision; and

2) supervision of psychotherapy.

In Lacy's view, applications need to be inobtrusive - in general - to support ecological validity and validity. Additionally, for clinical supervision and consultation activities, one needs at a minimum, 1) to securely store the data, and 2) a secure way to share it with a clinical therapy supervisor.

In the case of psychotherapy supervision, there are a few key points, particularly germane to home-based ABA-based therapies:

- Most therapy is not observed

- Competencies are not observed/documented

- Current video systems are cumbersome and expensive

THE SOLUTION:

Find a convenient and non-intrusive way to

Capture video data of the REAL behaviors that occur

In the Home

In Therapy Sessions

Securely store the data

Have a Secure Way to Share it with

Clinicians

Therapy Supervisors

Dr. Lacey went on to describe the system/package he has been developing atBehavior Imaging Solutions - a "proprietary 'out of the box' solution.
Lacy went on to illustrate the types of hardware which might be involved in video capture (from iPhone and Flip videocams to dedicated videocams), the process of providing feedback (through secure/compliant means), and utilizing the end result. He used as an example a course of treatment drawing on Applied Behavioral Analysis (ABA), where assessment of the 'real' and accurate behaviors under treatment are so essential. (It is a treatment of choice for severe autism in particular.) With ABA, treatment is dependent on a clear analysis of actual behavior, in terms of understanding the 'ABC' dynamic: Antecedents of Behavior, Behavior itself, and Consequences.

The videocam and software Lacy described have proven to be effective tools for "behavior imaging", providing 'on-demand capture via remote control with the push of a button', time buffering capability, ability to tag and mark video, automatic uploading, and security/HIPAA compliance. The web-based component entails an interactive, browser-based interface allowing 'anywhere, anytime access' and facilitating a secure online consultation and records environment. One can upload, organize, tag, utilize secure messaging, and maintain custom folders. Once data has been collected there are easy interface modules for data review and annotation.

Dr. Lacy mentioned a 2009/2010 study by the US Air Force with results suggesting the value of online ABA supervision. An ongoing focus has been on supporting home-based ABA, and supporting also ABA Therapy Supervisors and families/tutors. He described a study which utilized Flip cams as a means of gathering behaviorial data, and displayed a diagram of how families, tutors and ABA supervisors can asynchronously interact via the Behavior Connect platform. He displayed a map demonstrating how 5 Certified (ABA) Therapy supervisors are serving 31 families nationwide at present. A survey was done among these 5 supervisors, and their ratings of the system were as follows:

Clinically Sound: 100%
Effective Delivery: 80% (~ 4 out of 5 in this small sample)
High Value: 100%
Easy to Use: 100%

In terms of supervision (as opposed to treatment), trainees and supervisors utilize the HIPAA compliant server for sharing web-based supervision records, using encrypted video, tagged events, and various permission and feedback forms.

Current users include: behavior health clinics, medical schools, universities, hospitals, school districts, state Depts. of Education, the US Dept. of Defense It is utilized presently in 5 countries, and 31 states.
Dr. Lacy concluded by asking us to think about all the potential applications, from psychiatric residency programs to daily clinical practice. For example, perhaps a patient with OCD is too ashamed to talk at length about their hoarding behavior. Non-obtrusive recording of behavior around the home might be instructive and offer a more-informed basis for understanding behavior.

--

Dr. Carll recalled the power of a videotape being brought into a session, and the impact of seeing aggressive, negative behavior 'disappearing'. She thanked Dr. Lacy, and introduced the final panelist to present today, Dr. John Cabiria.

Dr. Jon Cabiria would round out the presentations today with a look at Augmented Reality: What it is (as opposed so some of the immersive virtual reality applications which have been discussed), how it can benefit psychologists and clients, and future directions for research.

Within the context of 'the interface of human experience and technology'- almost verbatim the prevailing functional definition of 'cyberpsychology'! - Augmented Reality has distinctive characteristics.

What is
Augmented Reality?

As illustrated above, AR is seen as residing along a continuum of experience, ranging from fully 'real', immediate, non-manipulated experience to fully immersed virtual reality. In between one can find both 'augmented' reality, where a virtualized component is introduced, and 'augmented virtuality', where a predominantly virtual environment is augmented by (Real life) reality. Specifically

Augmented Reality

- is a process by which digital images are overlaid upon real world spaces

- combines real and virtual images into one 3D display

- lets people interact and manipulate these digital images as if they were in real space

In everyday experience, both on the web with big-screen viewing and on smart phone (and tab) devices as well,there are several good examples - one is onscreen now - of '3D-ish' city maps and tagged streetscapes. [Layar-augmented reality is getting a lot of attention - Layar is the cleverly-named mobile mapping-tagging browser/application for anyone who wants, needs, or doesn't want to know about that. It allows 'smart phones' to display tagged and photo-realistic maps for seemingly infinite purposes.

I am reminded of sites on the big screen (computer w/monitor, which many do prefer!) - tagging shared media, tagging a whole lot on social networks like Facebook, location tagging with Foursquare and foto-tagging on Flickr ... and that's only a few of the F's).

On the (big) screen above we are seeing Streetscapes. After several sessions I've been to covering virtual environments, on the screen here now, I am immediately struck by the 'image quality': it's crisp and photographic, like only "real" video or digital/film media typically offers. It's the reality of some (recent?) moment, captured photographically in detail. Augmented, in this case by the tagging capability all over the streetscape, and the ability to productively tap into the tagged community's shared knowledge. Example, "You can filter by tag". Let's say you're downtown somewhere while you're traveling. You tap into the Streetscape and see the local neighborhoods. With tags all over the place. Filter/search say for 'coffee shops' in general, or 'coffee shops with wi-fi', and it will take you there. Virtually, of course, Via augmented reality with tons of marketing, user, and and technological assistance. :-)

Having seen this on the big screen there (and 'here'), I can tell you that not only is the view of the street really sharp, and the 3D-ishness nice too. But it really gave the feel of sitting in a cafe and looking out into the street through 2 panes of glass window. A lot going on out there. All tagged! (I find myself forever repeating, context is everything.) Moving on to....

---

The Virtual Conference Room

Moving from Augmented Reality now, one notch over towards the other end of the 4-point Mixed Reality spectrum into

Here we are shown a sort of CGI'ish, very realistic (and very lovely and well appointed) conference room. It's very realistic, but it's augmented virtuality.

"It doesn't take much to fool the mind." He added that this can happen within a matter of seconds (the shifting of mindset into accepting what's seen as 'real').

Samples along the reality spectrum are onscreen again. Now we see...

Virtual History

He scrolls a plot of land over time... let's say, the Coliseum or Stonehenge or New Orleans and the image shifts. Time Machine. Augmented reality.

Virtual Anatomy

Here we see some amazing images. My immediate visceral reaction to one: 'A skeleton attached to a body!' But I was distracted by the red circle around the ribs. What it shows is a not-animated, real youth with a carve-out of his mid-section (virtually only!) so one can clearly see his drib structure. Another is again a real person's near-complete image with a computer-guided zoom-view of his lungs, in particular, merging the real rest of him with a slice of virtual. Augmented Reality. Imagine the medical implications.
.

Ending this virtual tour along the mixed-reality continuum, Dr. Cabiria shared onscreen some of the myriad choices in hardware out there these days. [Including Kinect. -g-]

Imagine if you can... an iPad screen full of digitalized, 3D cityscapes with gazillion of user provided tags etc. On the other tablet we see someone in beautiful snowy Central park holding up an AR view from exactly where she stands so holding up the screen looks like she's got in the lens of a camera. Maybe she does.

There are wide variety of goggles out there, some rather stylish, some customized for just one eye or for partial immersion/partial in vivo vision, or something like that. Gone from this collection are the clunky, sometimes very elaborate complete VR immersion goggles we see, for example, with the hospital-based pain management program described earlier. In addition to the goggles, a wide assortment of video cams where show onscreen.

Dr. Cabiria noted that in part, our readiness with all the hardware is "one of the reasons for the growing popularity... we already have the hardware."

Flash to a super closeup of a virtual eyeball with a the center of their eye consisting of what I'd describe as a greenish-tinted concentric test-pattern display. The latest cool contact lens? Not exactly (yet). It's a contact lens with a camera (so a computer and beyond can see exactly what you see). It's also a display screen so you can be driving your car on Mars - no, I mean - well, yes, one can be immersed I suppose in 2-way virtual visual eye contact and data. Great implications for research, but not for driving - yet.
Software

Cabiria was spot on, and I'm sure speaking for many technology adopting/adapting APA members, across generations and demographics, when he paused and noted: "When AR hits APA we know we've arrived." There definitely have been larger audiences and more informed comments and questions at this year's technology and Internet related events - for practitioners, students, educators and researchers.

Clearly of great interest to psychologists here today (and students/interns/others too), is the use of VR/VE in therapies. Most of have heard about the history of early VR-based treatments and the classic simple-phobia types (e.g., spiders) which were used in the first days applied behavioral health with augmentation &/or virtualization. Today we were shown the '2.0 version' in effect, awesomely realistic realtime views of the patient's outstretched arm (100% real, or real as can be with video). Suddenly on the hand: Spider! big and fuzzy... I suppose/hope this was at the highest level of exposure - thus a success story! Yes, VR treatment with phobias has a long strong evidence evidence base. [As Kate Cavanagh noted earlier, some virtual treatments are prescribed in the UK as the treatment of choice, based on efficacy data.

Implications

Cabiria presented some varied branches, or interest areas of psychology, and the implications of all this new technology across daily-life domains.

Social Psychology: His list of implications began with online identity management. This term comes from John Suler's classic Psychology of Cyberspace a decade + ago - before Facebook & Twitter although at the peak of some engaging online VR communities. Hot topics then: flaming, trolling, emoting behavior, etc. I wonder how much has changed but change is everywhere and diverse. I would call this area of research social cyberpsychology and I might imagine and hope for some cybersociologists out there a well.

Dr. Cabiria mentioned some other 'classic' works which still provide great grist for social psychology research mill. Among them Prensky's (2001) treatise on 'Digital Natives', and still going back further in techno-virtual time, Toffler's 1970 'Future Shock'.

Cognitive Psychology :

Here we begin with "our perceptions of the world and people around us, and the meaning we give to these new relationships with people, objects, and sensations, which are a blend of real and virtual.

Attention:

When reality is augmented, what does it demand of our attention? To me that is the heart of it. What are we attending to, for how long, using what resources, how effectively, with what tools?

Neuroscience:

Are we re-wiring our brains? (How? How fast? Adapting to what?) Which lead to a big implication of all this evolution/revolution with technology and Internet...

Evolutionary Psychology:

"How are our most primitive stimulus/response mechanisms responsive to ever-increasing modern advances that change the way we are programmed to relate to ourselves, each other and the world around us?"

But Dr. Cabiria left us with take-away: some links to explore as home work, to supplement this asynchronously live, mixed media, mixed reality report.It's on You Tube, actually. Fun, fascinating, no real work at all to watch & learn. The amazing Hans Rosling, and Augmented City in 3D. You'll definitely get a sense of the power of augmented reality.

* Requires SIMPLE red/blue cellophane 3D glasses. See this great example of augmented reality here now if you'd like - cyber room service

Check it out, the bigger the screen the better. No goggles or immersion suit needed for the 3D clip - but you do need to use a simple old-fashioned 2-color set of 3 D glasses. I picked up some old cardboard 3-D glasses- one red one blue 'lens' - and watched this video. I would say it is 'impressive' and would add as my last editorial comment that we in the US have among the slowest (and narrowest) broadband on earth. In more Internet-developed countries there must surely be some additional and amazing uses of the technology we already have - but with great video streaming so that the connection is not obtrusive (op.cit Dr. Lacy's point)

Cabiria: "It's coming. It's here to stay.
And back to the present here and now...

Our session is up for today. :-)

Dr. Carll thanked the presenter, and reflected - referring to the busily tagged StreetScene - what amazing implications, clearly for marketing too. Walking down the street and an image pops up inviting you inside for a cold Perrier...

Yes the wave of technological advances and human adaptation continues. Finally now in the few remaining moments, questions?

Audience Q & A

Question: I'm really interested in the boundaries an ethics issues. Is there anything out there to simulate situations which may arise?

Answer (Rizzo): It may require a 'small leap', but people are working with licensing boards on developing some training tools. You can't really anticipate the provocative patient for example, or train for every possibility. In medicine, one can come up with sophisticated training tools, for example using 'standardized actors'. In part, who has the research contracts impacts the collective research: "a matter of funding"

Question: How could someone like me get access to technology?

Answer (Cabiria): One quick and easy way: Second Life. Although it is 'clunky'. There's a learning curve, true, but people do adapt. A study done in 2008 found examples of a gay/lesbian population reporting that they "felt more real in the virtual world and more inauthentic in the real world...once you get past the clunky interface there's a lot you can do.

Question: Is the software free? I'd like to create a virtual office where I can interview clients with an avatar.

Answer (Lacy): "Second Life is not secure - but it's cool. A bit cartoonish, fun to fly around...InWorld Solutions and others are designing modules and platforms for clinicians. Web-based services. Instead of buying the equipment, you can subscribe to the service. We're not there yet, but soon.

Answer/comment (Rizzo): Your biggest obstacle [trying to make a home-made virtual office] is wanting to author your own content. You can do that using existing platforms like Virtually Better and in World Solutions. Rizzo said development costs, from that perspective, are high right now, part of the problem at this point of time being 'just selling it'.

Comment (Lacy): Dr. Lacy agreed: some of the really robust and well researched programs, such as Virtually Better and Virtual Iraq, made it through design, research, development and deployment only because the team were well funded and could afford it.

And back to the present here and now...

Our session is up for today. :-)

So much has been presented these past few days by experts at the cutting edge of VR/VE applications, and now AR, AV ... immersion and subtle, interactive and informational... There is a great deal to process still. I've learned a lot thanks to these great presentations - hope you have too!

Next up for me: Love online, Social Networks' Impact on Kids, and the status of US Licensing laws